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钙化性肌腱炎

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Recovery after arthroscopic excision of a calcific deposit, from early movement to full activity.

Updated Jun 2026
物理治疗师在患者手臂向侧方轻柔抬起时给予支撑的示意图。
钙化性肌腱炎治疗后恢复舒适的活动。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

本康复方案涵盖由 Kieran Hirpara 医生在罗克汉普顿 Mater 私立医院进行的关节镜下钙化沉积物切除术后的康复：即通过微创（钥匙孔）手术从肩袖肌腱中清除钙质沉积，有时同时进行肩峰下减压术，以为肌腱腾出更多空间。请在您首次就诊物理治疗时带上本页或其 PDF，以便您的康复保持协调一致。您的康复将由物理治疗师根据肩部的恢复情况，按下列各阶段为您逐步推进。

如果您在手术后对伤口有任何顾虑，请与诊室联系。拍下伤口照片并通过电子邮件发送以供查看，通常会有所帮助。

如果切除沉积物需要进行肩袖修补（沉积物有时会在肌腱上留下需要缝合闭合的缺损），您的恢复将改为遵循肩袖修补的规则，此时肩袖修补方案的优先级高于本页。若此情况适用于您，Hirpara 医生会在手术后告知您。

您可以期待什么

两种路径都是早期活动路径。除非肩袖需要修补，否则没有任何缝合部位需要数月的保护；治疗的目标是消除疼痛的来源，而康复的目标是平复治疗后的急性发作，保持肩部活动以免其僵硬，然后重建力量。

  • 在关节镜下切除术后，会提供一个吊带，仅供舒适之用。它只需短暂佩戴，通常为数天，很少超过两周，并且应尽可能少戴。您无需戴着它睡觉。恢复到完全、不受限制的活动通常约需三个月。

佩戴吊带时请勿驾车。驾车通常从约两周后恢复，前提是您已脱离吊带、感觉舒适，并能安全地完成紧急刹车。

无论采用哪种治疗，肩部都可能需要时间才能完全平复。不适往往是分阶段而非一次性地改善，手术后可能需要数月（偶尔长达九个月）治疗前的症状才会完全消退。稳步改善，而非即刻的舒适，才是预期的过程。

这是通过若干个小切口进行的微创日间手术。钙化沉积物位于肩袖肌腱内并被清除，同时往往还会进行肩峰下减压术以给肌腱更多空间。敷料通常在约两天后即可去除，伤口会在术后约一周至十天的首次复诊时进行检查。

第一阶段——早期活动（第0–2周）

您从手术中醒来时，手臂会置于吊带内，但吊带仅供舒适之用：请尽量少戴，多数人在数天内即可脱离吊带。从一开始，您就可以在肩部高度以下不受限制地使用手臂。将手臂举过肩部高度是允许且安全的，尽管起初会感到不适；每天数次，用健侧手臂帮助将术侧手臂举过肩部高度作为轻柔的伸展，以免肩部僵硬。在最初几周内，术侧手臂请避免携带超过约两公斤的物品，否则会引起疼痛。请尽快开始您的练习，每项动作以10次为目标，每天三次。请在练习前服用止痛药，并用冰敷以缓解不适。佩戴吊带时请勿驾车。

致您的物理治疗师：

目标

  • 平复术后疼痛与肿胀
  • 早期恢复活动范围：首要任务是防止僵硬，钙化性肌腱炎患者尤易发生僵硬
  • 在肩部高度以下正常使用手臂

处理措施

  • 吊带仅供舒适之用；在舒适允许的情况下尽快脱离，通常在数天内
  • 从第一天起在肩部高度以下不受限制地主动使用手臂
  • 在可耐受的范围内主动上举至肩部高度以上
  • 每天数次（使用另一只手臂）进行肩部高度以上的被动及主动辅助上举，以防止僵硬
  • 家庭练习方案每项动作10次，每天三次
  • 练习前给予镇痛；根据需要冷疗以缓解疼痛

注意事项

  • 术侧手臂不得携带或提举超过约两公斤的物品
  • 佩戴吊带时不得驾车

进阶标准

  • 首次术后复诊时伤口检查满意
  • 已脱离吊带并能在肩部高度以下舒适地使用手臂

第二阶段——恢复您的活动范围（第2–8周）

您将在约两到三周时于诊室接受复诊，届时会检查您的伤口和被动活动范围。本阶段的重点是活动范围：推进您的前向上举伸展，并加入向侧方的动作，由物理治疗给予进阶指导。典型目标是在六周时能主动将手臂抬至水平位，并在六周时使辅助（被动）活动范围（前向、侧向及旋转）恢复正常。驾车可从约两周后恢复，前提是您已脱离吊带、感觉舒适，并能安全地完成紧急刹车。

致您的物理治疗师：

目标

  • 六周时主动前屈和外展达到水平位
  • 六周时被动前屈、外展和外旋恢复正常
  • 能独立完成日常活动

处理措施

  • 推进被动及主动辅助前屈；引入并推进外展
  • 在舒适允许的情况下进阶至各平面的主动活动范围
  • 继续肩胛骨定位及姿势练习
  • 继续在治疗前镇痛，并根据个人偏好在伸展前后热敷或冰敷

注意事项

  • 在活动范围恢复期间保持轻量提举；进阶仍以症状为导向
  • 伸展至明显不适是可以接受的；强行的、剧烈疼痛的伸展则不可取

进阶标准

  • 被动活动范围达到或接近正常
  • 主动上举达到水平位或更佳，且疼痛正在平复

第三阶段——力量训练与恢复完全活动（第8–16周）

您通常会在约八周时再次接受复诊。在活动范围恢复后，康复转向锻炼肩袖力量，通常在物理治疗师的监督下进行，并自由地在肩部高度以上使用手臂。目标是在约十二周时实现完全的主动前向上举和外展。仅切除沉积物后的恢复通常约需三个月，之后不再有任何限制；如果肩袖需要修补，恢复期会更长（通常约五个月），并改为遵循肩袖修补方案。如果部分酸痛持续到这一时间点之后也无需担忧：在这项手术后，术前症状可能需要长达九个月才能完全平复，而总体趋势则稳步朝着正确的方向发展。

致您的物理治疗师：

目标

  • 约十二周时完全的主动前屈和外展
  • 逐步恢复肩袖及肩胛骨的力量与耐力
  • 约三个月时恢复完全、不受限制的活动

处理措施

  • 从八周起进行渐进性肩袖力量训练：从等长练习进阶至弹力带及轻重量练习，低负荷、较高次数
  • 推进在肩部高度以上主动使用手臂
  • 在第十二至十六周期间，在可耐受的范围内推进针对健身、工作及运动的专项负荷

注意事项

  • 力量训练不应以牺牲活动范围为代价；全程持续进行活动度练习
  • 逐步增加重负荷及过头负荷；一旦出现疼痛发作，即意味着后退一步

进阶标准

  • 完全的主动活动范围，力量正在恢复，症状持续平复
  • 进展良好时从常规随访中出院，通常在约八至十六周之间

完成您的方案之后

上述各阶段改编自本手术已发表的患者指南和康复方案：伦敦肩部合作组织（The London Shoulder Partnership）的钙化沉积物切除术康复方案、ShoulderDoc（英国）关于钙化性肌腱炎手术的患者指南，以及 Kevin Ko 医生关于关节镜下切除术的患者指南。各周数范围为典型值而非固定值，您后续的康复将由物理治疗师与本诊所协作，根据您肩部的恢复情况为您个别指导。本页与本诊所的一般恢复建议配合使用：请参见术后疼痛管理和伤口护理。关于疾病本身以及这些治疗的原理，请参见钙化性肌腱炎。本方案背后的证据（自然病程、针刺抽吸术以及手术切除相关文献）总结于证据部分，可从本页顶部以 PDF 形式获取。

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Calcific Tendinitis of the Rotator Cuff — Staged Management & Post-operative Rehabilitation (Arthroscopic Excision)

Topic scope: (A) the natural history and stepped non-operative management of rotator-cuff calcific tendinitis (rest/analgesia → barbotage ± subacromial steroid → ESWT), and (B) post-operative rehabilitation after arthroscopic excision of the calcific deposit (± subacromial decompression; the cuff-repair pathway defers to the rotator-cuff-repair protocol).

Defining principle of the surgical rehab here: arthroscopic excision removes the source of pain and does not, by itself, create a construct that needs months of protection — provided the rotator cuff is left intact. So (like a debridement/decompression, and unlike a cuff repair) the rehab is an early-movement pathway: short sling for comfort only, unrestricted use below shoulder height from day one, assisted elevation to prevent stiffness, strengthening from ~8 weeks. The single branch point is whether removing the deposit left a tendon defect that needed repair — if so, the recovery converts to the slower, protected rotator-cuff-repair pathway.

A. NATURAL HISTORY & NON-OPERATIVE MANAGEMENT

Natural history (self-limiting in most)

Rotator-cuff calcific tendinitis is self-limiting in the majority: after a variable quiescent period the deposit enters a resorptive phase (peripheral vascularisation + phagocytosis), and spontaneous resorption occurs in roughly two-thirds of cases within 1–2 years [Uhthoff & Loehr; Chianca 2018 review]. This underpins a non-operative-first approach and explains why post-operative residual calcium that "dissolves spontaneously" does not harm the outcome.

Stepped non-operative interventions

  1. Analgesia / activity modification / physiotherapy — first line; many settle as the deposit resorbs. Consensus.
  2. Ultrasound-guided barbotage (needling + lavage), usually + subacromial corticosteroid — the best-supported interventional option. A systematic review of 908 patients and subsequent meta-analyses favour barbotage for medium-term pain/function; barbotage + subacromial steroid improves Constant–Murley score and reduces deposit size vs steroid alone. Notably, clinical improvement is NOT dependent on how much calcium is aspirated — perforating the deposit to trigger resorption is the active mechanism. Moderate–strong (SR/RCT).
  3. Extracorporeal shock-wave therapy (ESWT) — reduces deposit size and pain; broadly comparable to barbotage in several comparisons. Moderate (RCT).

B. POST-OPERATIVE REHABILITATION (arthroscopic excision ± subacromial decompression)

Surgery is reserved for deposits recalcitrant to adequate non-operative care. The operation locates and removes the deposit from within the cuff tendon, often with a subacromial decompression for room. Key surgical-outcome facts that shape the rehab:

  • Preserving cuff integrity while removing as much deposit as possible gives good-to-excellent results in ~90% and avoids iatrogenic tendon defects [arthroscopic excision series].
  • Complete vs near-complete removal gives equivalent outcomes — residual calcium resorbs spontaneously afterwards; the surgeon need not chase every fleck at the cost of the tendon.
  • Arthroscopic decompression WITHOUT cuff repair is a validated strategy with good outcomes where the residual defect is not repaired [Bone & Joint 2023].
  • Symptom settling is gradual — significant pain relief and ROM gains are the norm, but the pre-operative symptoms can take up to ~9 months to fade fully; recovery to unrestricted activity after excision alone is ~3 months.

Phased post-op timeline (no cuff repair)

Phase Window Sling ROM / use Strengthening Notes
I — Early movement Week 0–2 Comfort only, days (rarely > 2 wk), off ASAP Unrestricted use below shoulder height from day 1; assisted elevation above shoulder height several × daily to prevent stiffness — Settle post-op flare; calcific patients are stiffness-prone → motion is the priority. ≤ ~2 kg, no driving while in sling
II — Regaining range Week 2–8 Off Progress active elevation; restore full passive + active ROM Begin gentle as pain allows Most regain comfortable range through this window
III — Strengthening / return Week 8–16 Off Full active elevation goal by ~12 wk Cuff + scapular strengthening from ~8 wk, isometric → band/light weight; advance work/sport loading wk 12–16 Full unrestricted activity ~3 months; discharge ~8–16 wk

Branch point — if a rotator cuff repair was required: recovery converts to the protected rotator-cuff-repair pathway (sling ~6 wk, ROM restrictions, strengthening deferred), typically ~5 months total. The surgeon confirms post-operatively which pathway applies.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Surgery is a last resort — given high spontaneous-resorption rates and effective barbotage/ESWT, excision is reserved for genuinely recalcitrant cases. Strong rationale.
  2. How much to remove / whether to repair the defect. Equivalent outcomes for complete vs partial removal, and viable decompression-without-repair, mean the surgeon balances deposit clearance against tendon integrity intra-operatively — which in turn decides the rehab pathway. Moderate.
  3. The post-op rehab protocol itself is consensus/expert, drawn from surgeon patient-guidance protocols rather than a rehab RCT — phase timings are typical, not trial-derived.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE–STRONG (SR / RCT): barbotage ± steroid for non-operative calcific tendinitis (908-patient SR; barbotage + steroid > steroid alone); ESWT efficacy.
  • MODERATE (cohorts): arthroscopic excision outcomes (~90% good-excellent; equivalence of complete vs partial removal; decompression without repair, Bone & Joint 2023); spontaneous resorption ~2/3 within 1–2 years.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol (surgeon patient-guidance documents; no defining rehab RCT).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles) — adjacent rotator-cuff evidence

  • Predictors of failure of non-operative treatment of chronic symptomatic rotator-cuff disease (2013 Neer Award). J Shoulder Elbow Surg. 2016. DOI: 10.1016/j.jse.2016.04.030
  • Arthroscopic rotator cuff repair: scientific rationale, surgical technique, early clinical results. J Shoulder Elbow Surg. 2010. DOI: 10.1016/j.jse.2009.12.012
  • Early versus delayed rehabilitation after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2024. DOI: 10.1002/ksa.12129
  • Speed of recovery after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2017. DOI: 10.1016/j.jse.2016.11.002
  • (The corpus is thin on calcific-tendinitis-specific rehab; the evidence base below is the calcific literature + published surgeon protocols.)

Calcific tendinitis literature (URLs)

  • Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients (DARE). https://www.ncbi.nlm.nih.gov/books/NBK241935/
  • Determining the efficacy of barbotage for pain relief in calcific tendinitis. JSES Int / ScienceDirect. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11401591/
  • Needling and lavage in rotator-cuff calcific tendinitis: ultrasound-guided technique. PMC. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10805427/
  • Calcific tendinitis of the rotator cuff: a review (natural history, phases, resorption). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC3749672/
  • Recovery pattern after arthroscopic treatment for calcific tendinitis of the shoulder. Orthop Traumatol Surg Res. 2020. https://www.sciencedirect.com/science/article/pii/S1877056820301043
  • Arthroscopic decompression of calcific tendinitis without cuff repair. Bone Joint J. 2023. https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B6.BJJ-2022-1137.R1
  • Arthroscopic treatment of calcific tendonitis (preserve cuff, ~90% good-excellent; residuals resorb). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4044535/

Published rehab protocols (patient-guidance — basis for the phase structure)

  • The London Shoulder Partnership — Calcific Deposit Excision Rehabilitation. http://thelondonshoulderpartnership.co.uk/shoulder/shoulder-rehabilitation/calcific-deposit-excision-rehabilitation/
  • Ko K. Arthroscopic Excision of Calcific Tendonitis — What Can I Expect? (OPA Orthopedics). https://www.kevinkomd.com/pdf/calcific-tendonitis.pdf
  • Funk L. Surgery for Calcific Tendinitis. ShoulderDoc. https://shoulderdoc.co.uk/pages/surgery-for-calcific-tendinitis

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Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.